Veterinary Telemedicine Begins to Take Off, But Challenges Remain

Milkshake and Pickles are reluctant travelers. So when Patience Warren needed to take the two elderly cats on a 12-hour drive in February, she was hoping to get some pharmaceutical assistance, especially for Pickles, a petite gray tabby with a history of severe motion sickness.

The dilemma: Taking Pickles to the vet typically triggered the very distress Ms. Warren was hoping to avoid.

“Within like a minute of being put into her carrier and put into the car, she would usually vomit or lose her bowels,” said Ms. Warren, a political researcher in Missouri. “She would also just cower and be really scared and meow. And I didn’t want to put her through that stress.”

Over the course of the pandemic, Ms. Warren had grown accustomed to having her own health needs met virtually, seeing a doctor, therapist and nutritionist online. She wondered whether there were veterinarians who might prescribe anti-anxiety and motion sickness medications over a video call. When she searched online, she was surprised to discover numerous options.

“I honestly didn’t realize that virtual vets existed,” she said.

While many people have embraced virtual visits with their own doctors, use of veterinary telemedicine by pet owners has lagged. In one new survey of more than 1,200 American cat owners, 72 percent reported using telemedicine for themselves, compared to just 3 percent who had used it for their felines.

“But things are changing, and things are changing fast,” said Carly Moody, an animal welfare researcher at the University of California, Davis, who conducted the survey, which has not yet been published, as part of an ongoing project studying telemedicine for cats.

During the pandemic, numerous states temporarily loosened restrictions on veterinary telemedicine and many clinics as well as pet owners tried remote appointments for the first time. Some states are now considering permanently expanding their use.

Although hurdles remain, and it’s not appropriate for all pet care scenarios, scaling up telemedicine could bring a variety of benefits, experts said, like improving access to veterinary care and reducing stress for vet-averse pets like Pickles.

For veterinary medicine, Covid-19 “served as a catalyst for change that was necessary,” said Dr. Christina Tran, a veterinarian at the University of Arizona who is on the board of directors of the Veterinary Virtual Care Association and is a paid adviser to a veterinary telehealth company.

Pandemic practices

Some forms of telehealth are decades old; veterinarians have long fielded frantic calls from pet owners or consulted with colleagues over email.

But remote video appointments are newer. “Before the pandemic, it was not very common to utilize telemedicine in that way,” said Dr. Lori Teller, the president of the American Veterinary Medical Association, who is also on the faculty at Texas A&M University, where she has developed a veterinary telehealth program. She is also a compensated adviser for another veterinary telehealth company.

In part, that stemmed from restrictive state laws, many of which required veterinarians to have a pre-existing relationship with an animal — including having given a prior hands-on exam — before treating them remotely.

But when the pandemic began, some states temporarily eased their requirements. Veterinary practices turned to telemedicine to conserve personal protective equipment and flatten the coronavirus curve. The share of vets offering remote video appointments rose to 30 percent from 4 percent, according to one survey of American and Canadian clinicians.

Pet owners who had never considered virtual care suddenly had few other options. One morning in May 2020, Kristyn Booth, an educator who then lived in Austin, Texas, discovered that her dog’s eye, which had been injured nearly a decade prior, was bulging and red. The veterinarian would only offer a virtual appointment.

Initially, Ms. Booth was nervous. “How can they do this?” she recalled thinking. “It’s her eye.”

But the veterinarian suggested that Ms. Booth drive Lily, a redbone coonhound, to the office and take the virtual appointment in the parking lot. If the situation looked serious, they could rush Lily inside.

So Ms. Booth sat inside her car and showed the doctor Lily’s eye over a video call. She followed the vet’s instructions to gently press around the dog’s eye socket and look under her eyelid for blood. “I felt like I was a vet that day,” she said. “They were right there in case it was going to go awry.”

The doctor prescribed eye drops and sent Ms. Booth and Lily on their way.

Last year, when Lily’s eye got worse, Ms. Booth used a video call again; this time, the doctor took one look and knew it was time for the injured eye to come out, Ms. Booth said. Lily has coped well, she added: “She’s great. She’s old now, and we do everything we can to keep her happy and healthy.”

Scaredy cats

Some organizations are pushing for a more permanent expansion of virtual vet care.

“The pandemic really did open up our eyes to the utilization of telemedicine,” said Kevin O’Neill, the vice president of state affairs for the American Society for the Prevention of Cruelty to Animals, which is urging states to loosen their rules around telemedicine. “We see it as a real key component to establishing a broader ability for patients and pet owners to be able to access that vet care that’s so badly needed.”

In June 2022, 26 percent of American pet owners reported that there had been times over the previous two years when they had been unable to access veterinary care, according to a survey of 5,000 people conducted by the A.S.P.C.A., which provided the data to The Times. Two-thirds of them said that their pets would probably be “seen by a veterinarian more often” if they could use telemedicine.

Although not all medical care can be provided through a screen, routine appointments like post-surgical follow-ups or behavioral consultations work fine from a distance, experts said.

Telemedicine could be especially useful for rural pet owners, who may live hours from an animal clinic, as well as those who cannot afford to take time off from work or lack reliable transportation, experts said. Virtual triage services could help people determine whether their pets’ symptoms require in-person care or can be monitored at home.

“And then we open up those appointments for the brick and mortar so that they can in fact see things that need to be seen in person,” Dr. Tran said.

Virtual care could also be a boon for cats, many of which are intensely stressed by trips to the vet, Dr. Moody said. In a small unpublished study funded by the A.S.P.C.A. and Maddie’s Fund, an animal welfare group, Dr. Moody and her colleagues found that cats displayed fewer signs of physiological stress — with smaller pupils, slower breathing rates and more relaxed ear postures — during remote appointments than during in-person ones.

When given clear instructions, cat owners could even do some basic physiological assessments usually performed by a vet. “I think we only had one cat that the owner wasn’t able to get a respiration rate at home because the cat was very wiggly,” said Grace Boone, a researcher in Dr. Moody’s lab who ran the study.

The virtual vet turned out to be perfect for motion-sickness-prone Pickles, who seemed to hate the vet just as much as she loved crashing Ms. Warren’s remote work meetings. “She loves being on camera during my work Zoom, so as soon as I turned it on, she was up on my lap,” Ms. Warren said.

The vet prescribed medication for motion sickness and anxiety, which were shipped directly to Ms. Warren’s home. “Overall, it was wonderful,” she said. “I’ve been telling everybody.”

Tele-troubles

Telemedicine is not a panacea, and some pet owners and veterinarians have run into its limitations.

When Alisa Crane’s 16-year-old cat developed an infection on his ears and face last November, the only appointment she could find was a virtual one. The appointment felt cursory, she said, lasting “maybe six minutes.”

The virtual veterinarian prescribed painkillers and antibiotics, and the infection eventually cleared, but Ms. Crane, who lives in Sudbury, Ontario, still doesn’t know what caused it or whether it was a sign of a deeper health issue. If she were in the same situation again, she said, she’d probably opt for an in-person trip to the expensive emergency vet. “I don’t think they were able to properly diagnose him through the video call,” she said.

After Friendship Hospital for Animals, in Washington, D.C., began offering telemedicine appointments for some patients in April 2020, some veterinarians soon found them to be more trouble than they were worth. “Because our patients can’t tell us their symptoms like a person can, I am relying on a pet owner to interpret their symptoms,” said Dr. Christine Klippen, an emergency veterinarian at the hospital. “And that can sometimes be very, very wrong.”

For instance, a pet owner who noticed their cat straining in the litter box might book an online appointment for constipation, typically a relatively minor ailment, when the cat in fact might have a urinary blockage, a potentially life-threatening emergency, Dr. Klippen said.

“We would get a lot of folks that would not find the animal in time,” she added. “You’d have a scheduled appointment, and then they’re trying to take video of pets in the closet. It didn’t turn out to be an efficient use of the veterinarian’s time.”

The hospital discontinued the appointments after less than six months, she said, although the hospital does occasional remote consultations. Virtual care is a “great idea,” she added, but vets and pet owners need clearer guidelines about how and when to use virtual visits.

The legal landscape can be confusing too, with a patchwork of state and federal laws. But some states are embracing telemedicine. New Jersey, for instance, now allows vets to treat new patients virtually without a prior physical examination, and Arizona lawmakers are considering similar legislation.

The American Veterinary Medical Association favors a more restrictive approach, largely limiting telemedicine to pet owners and veterinarians with a pre-existing relationship, with limited exceptions for emergencies and specialists. But Dr. Teller said that she expected a growing number of practices to offer virtual options.

“Now that pandemic craziness overall is slowing down,” she said, “it’ll be easier for veterinarians and their teams to take a breath and figure out how to better integrate telemedicine.”